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Obstetrics and Gynecology Jan 2018Nausea and vomiting of pregnancy is a common condition that affects the health of a pregnant woman and her fetus. It can diminish a woman's quality of life and also... (Meta-Analysis)
Meta-Analysis Review
Nausea and vomiting of pregnancy is a common condition that affects the health of a pregnant woman and her fetus. It can diminish a woman's quality of life and also significantly contributes to health care costs and time lost from work (1, 2). Because morning sickness is common in early pregnancy, the presence of nausea and vomiting of pregnancy may be minimized by obstetricians, other obstetric care providers, and pregnant women and, thus, undertreated (1). Furthermore, some women do not seek treatment because of concerns about the safety of medications (3). Once nausea and vomiting of pregnancy progresses, it can become more difficult to control symptoms. Treatment in the early stages may prevent more serious complications, including hospitalization (4). Safe and effective treatments are available for more severe cases, and mild cases of nausea and vomiting of pregnancy may be resolved with lifestyle and dietary changes. The woman's perception of the severity of her symptoms plays a critical role in the decision of whether, when, and how to treat nausea and vomiting of pregnancy. Nausea and vomiting of pregnancy should be distinguished from nausea and vomiting related to other causes. The purpose of this document is to review the best available evidence about the diagnosis and management of nausea and vomiting of pregnancy.
Topics: Advisory Committees; Antiemetics; Evidence-Based Medicine; Female; Humans; Maternal Health; Morning Sickness; Nausea; Obstetrics; Practice Guidelines as Topic; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, First; Severity of Illness Index; United States; Vomiting
PubMed: 29266076
DOI: 10.1097/AOG.0000000000002456 -
Nursing Standard (Royal College of... Aug 2016Essential facts Eight out of ten pregnant women are affected by nausea and vomiting in pregnancy. It is one of the most common reasons for pregnant women being admitted...
Essential facts Eight out of ten pregnant women are affected by nausea and vomiting in pregnancy. It is one of the most common reasons for pregnant women being admitted to hospital. Despite being known as morning sickness, symptoms can occur at any time of the day or night. The severe form of nausea and vomiting in pregnancy, hyperemesis gravidarum, is much rarer and affects up to 3% of pregnant women. For most women, their symptoms improve or disappear by around week 14, although for some it can last longer.
Topics: Female; Humans; Hyperemesis Gravidarum; Nausea; Pregnancy; Quality of Life; United Kingdom
PubMed: 27507366
DOI: 10.7748/ns.30.50.15.s16 -
Journal of Population Therapeutics and... 2014Nausea and vomiting of pregnancy (NVP) affects up to 85% of pregnant women, with varying degrees of severity. The most severe form of NVP, known as hyperemesis... (Review)
Review
Nausea and vomiting of pregnancy (NVP) affects up to 85% of pregnant women, with varying degrees of severity. The most severe form of NVP, known as hyperemesis gravidarum (HG), affects up to 2% of pregnancies. Women who have suffered with severe NVP/HG in a previous pregnancy have a 75-85% recurrence rate. Both patients and physicians often fear the use of pharmacological therapies during pregnancy due to the concerns of potential risks to the fetus. The symptoms and impact of NVP and HG can vary greatly among women, therefore treatment must be tailored to the individual. Updated Motherisk guidelines are presented.
Topics: Abnormalities, Drug-Induced; Adaptation, Psychological; Antiemetics; Female; Fluid Therapy; Humans; Hyperemesis Gravidarum; Morning Sickness; Patients; Perception; Pregnancy; Quality of Life; Risk Assessment; Risk Factors; Risk Reduction Behavior; Severity of Illness Index; Treatment Outcome
PubMed: 25654792
DOI: No ID Found -
Gastroenterology Jul 2022The liver disorders unique to pregnancy include hyperemesis gravidarum, intrahepatic cholestasis of pregnancy, acute fatty liver of pregnancy, and... (Review)
Review
The liver disorders unique to pregnancy include hyperemesis gravidarum, intrahepatic cholestasis of pregnancy, acute fatty liver of pregnancy, and preeclampsia-associated hepatic impairment, specifically hemolysis, elevated liver enzymes, and low platelet count syndrome (HELLP). Their importance lies in the significant maternal and fetal/neonatal morbidity and mortality. Expeditious diagnosis and clinical evaluation is critical to ensure timely, appropriate care and minimize risks to the pregnant woman and her fetus/baby. A multidisciplinary approach is essential, including midwives, maternal-fetal-medicine specialists, anesthetists, neonatologists, and hepatologists.
Topics: Cholestasis, Intrahepatic; Female; HELLP Syndrome; Humans; Hyperemesis Gravidarum; Infant, Newborn; Liver Diseases; Pre-Eclampsia; Pregnancy; Pregnancy Complications
PubMed: 35276220
DOI: 10.1053/j.gastro.2022.01.060 -
Clinical Obstetrics and Gynecology Dec 2001
Review
Topics: Acupressure; Antiemetics; Complementary Therapies; Dicyclomine; Doxylamine; Drug Combinations; Female; Zingiber officinale; Humans; Hyperemesis Gravidarum; Nausea; Pregnancy; Pyridoxine; Safety; Vomiting
PubMed: 11600848
DOI: 10.1097/00003081-200112000-00005 -
Pharmacology 2017In the United States, hyperemesis gravidarum is the most common cause of hospitalization during the first half of pregnancy and is second only to preterm labor for... (Review)
Review
BACKGROUND
In the United States, hyperemesis gravidarum is the most common cause of hospitalization during the first half of pregnancy and is second only to preterm labor for hospitalizations in pregnancy overall. In approximately 0.3-3% of pregnancies, hyperemesis gravidarum is prevalent and this percentage varies on account of different diagnostic criteria and ethnic variation in study populations. Despite extensive research in this field, the mechanism of the disease is largely unknown. Although cases of mortality are rare, hyperemesis gravidarum has been associated with both maternal and fetal morbidity. The current mainstay of treatment relies heavily on supportive measures until improvement of symptoms as part of the natural course of hyperemesis gravidarum, which occurs with progression of gestational age. However, studies have reported that severe, refractory disease manifestations have led to serious adverse outcomes and to termination of pregnancies.
SUMMARY
Despite extensive research in the field, the pathogenesis of hyperemesis gravidarum remains unknown. Recent literature points to a genetic predisposition in addition to previously studied factors such as infectious, psychiatric, and hormonal contributions. Maternal morbidity is common and includes psychological effects, financial burden, clinical complications from nutritional deficiencies, gastrointestinal trauma, and in rare cases, neurological damage. The effect of hyperemesis gravidarum on neonatal health is still debated in literature with conflicting results regarding outcomes of birth weight and prematurity. Available therapy options remain largely unchanged in the past several decades and focus on parenteral antiemetic medications, electrolyte repletion, and nutritional support. Most studies of therapeutic options do not consist of randomized control studies and cross-study analysis is difficult due to considerable variation of diagnostic criteria. Key Messages: Hyperemesis gravidarum carries a significant burden on maternal health and US health care. Most published research on pathogenesis is observational and suggests multifactorial associations with hyperemesis gravidarum. Precise, strictly defined criteria for clinical diagnosis are likely to benefit meta-analyses of further research studies regarding pathogenesis as well as therapeutic options.
Topics: Antiemetics; Female; Humans; Hyperemesis Gravidarum; Pregnancy
PubMed: 28641304
DOI: 10.1159/000477853 -
Emergency Medicine Australasia : EMA Feb 2022Nausea and vomiting in pregnancy (NVP) are common in early pregnancy but there is a wide spectrum of severity in terms of the duration and acuity of symptoms throughout... (Review)
Review
Nausea and vomiting in pregnancy (NVP) are common in early pregnancy but there is a wide spectrum of severity in terms of the duration and acuity of symptoms throughout gestation. Adverse maternal and fetal outcomes have been seen in women who experience severe symptoms, also known as hyperemesis gravidarum (HG). Evidence-based, assessment and management can reduce symptom severity, avoid physical and psychological deterioration and minimise the impact on quality of life and function. A pathway for assessment and management of NVP and HG in the emergency room is presented based on the Society of Obstetric Medicine of Australia and New Zealand Guideline for the Management of Nausea and Vomiting in Pregnancy and Hyperemesis Gravidarum. Assessment requires an objective evaluation using a validated scoring system such as the PUQE-24 score, as well as calculation of hydration and nutritional status. Ketonuria is not associated with either the diagnosis or severity of HG. Further investigation including biochemistry is only required in severe cases. Many women will have tried a range of therapies and an important aspect of treatment is to recognise the validity of their symptoms. Treatment may require a combination of intravenous fluids, anti-emetics, acid suppression and laxatives. Outpatient management is optimal but admission may be required for refractory symptoms, organ dysfunction or concurrent significant co-morbidities. Emergency management of NVP and HG requires an appropriate pathway of care to support women until the natural resolution of their condition. Both underuse of safe therapies and overuse of ineffective medication must be avoided.
Topics: Antiemetics; Female; Hospitalization; Humans; Hyperemesis Gravidarum; Nausea; Pregnancy; Quality of Life
PubMed: 34872159
DOI: 10.1111/1742-6723.13909 -
Clinical Medicine (London, England) Sep 2020A 34-year-old woman (gravida 4; para 3) at 17 weeks of pregnancy presented with abnormal behaviour for 3 weeks associated with difficulties in walking. She had been...
A 34-year-old woman (gravida 4; para 3) at 17 weeks of pregnancy presented with abnormal behaviour for 3 weeks associated with difficulties in walking. She had been admitted 2 months prior with hyperemesis gravidarum and was also diagnosed with thyrotoxicosis. Vomiting and poor oral intake persisted after discharge. She was euthyroid otherwise. Clinical examination revealed a dehydrated and confused patient. She had nystagmus and ataxic gate. Magnetic resonance imaging of the brain showed symmetrical signal changes of posteromedial part of thalamus. A diagnosis of Wernicke's encephalopathy (WE) was made and intravenous thiamine was given leading to gradual improvement of symptoms. Her thyroid function test normalised without any treatment. WE can occur in severe hyperemesis gravidarum. Prompt recognition of WE and replacement with thiamine is important to prevent neurological sequelae and mortality. Gestational transient thyrotoxicosis, which is self-limiting, is more prominent in patients with hyperemesis gravidarum and requires only symptomatic treatment.
Topics: Adult; Female; Humans; Hyperemesis Gravidarum; Magnetic Resonance Imaging; Pregnancy; Thiamine; Thyrotoxicosis; Wernicke Encephalopathy
PubMed: 32934066
DOI: 10.7861/clinmed.2020-0151 -
Midwifery Sep 2000A literature survey investigating the use of herbs to treat morning sickness, with particular reference to what is known about their safety. (Review)
Review
OBJECTIVE
A literature survey investigating the use of herbs to treat morning sickness, with particular reference to what is known about their safety.
DESIGN
All major English language medical, nursing and scientific databases as well as 300 World Wide Web sites, Internet newsgroups, books and magazines were searched for information about the use and safety of herbs in pregnancy.
FINDINGS
A search of medical databases failed to locate any articles which specifically reported investigations of the safety of herbs used during pregnancy. Of 300 non-medical sources studied 75 cited the use of herbs in pregnancy. The most commonly cited herbs for morning sickness were ginger, chamomile, peppermint and raspberry leaf (55, 37, 44 and 63% cited respectively). There was no consensus in the popular literature about whether or not each of these herbs was safe for use in pregnancy. Seven sources (6%) cited chamomile and peppermint as unsafe, while 16 (12%) cited the use of ginger and 11 (15%) the use of raspberry leaf as unsafe during pregnancy.
CONCLUSIONS
Herbal remedies are often seen as safe, 'drug-free' treatments for morning sickness. However, the contradictory information and dearth of original research related to their safety indicates that these compounds should be used with caution.
Topics: Female; Humans; Hyperemesis Gravidarum; Nausea; Patient Education as Topic; Phytotherapy; Plant Preparations; Pregnancy; Prenatal Care; Vomiting
PubMed: 10970756
DOI: 10.1054/midw.1999.0209 -
Canadian Family Physician Medecin de... Feb 2013I received a telephone call from my sister who lives in the United States. She is experiencing moderate symptoms of morning sickness, but she tells me that she was...
QUESTION
I received a telephone call from my sister who lives in the United States. She is experiencing moderate symptoms of morning sickness, but she tells me that she was advised to treat her symptoms only pro re nata- meaning, when symptoms re-emerge. Does this make sense?
ANSWER
No, it does not. Typically, nausea and vomiting of pregnancy continue for weeks and months, and in some cases until labour. It is critical to treat symptoms consistently so the woman can maintain adequate fluid and calorie intake. When symptoms improve, the dose of antiemetic medication should be decreased gradually.
Topics: Antiemetics; Female; Humans; Morning Sickness; Pregnancy
PubMed: 23418239
DOI: No ID Found